Kid Fail Reg

Question 1

Homeostatic kidney function

Answer 1

Electrolyte balance
Acid base balance
Volume homeostasis

Question 2

Kidney endocrine function

Answer 2

Erythropoietin

1 alpha-hydroxylase vitamin D

Question 3

Kidney excretory function

Answer 3

Nitrogenous waste
Hormones
Peptides
Middle sized molecules 
Salt and water

Question 4

Kidney glucose metabolism

Answer 4

Gluconeogenesis

Insulin clearance

Question 5

Kidney failure homeostatic

Answer 5

Increased potassium
Decreased bicarbonate 
Decreased pH
Increased phosphate 
Salt and water imbalance

Question 6

Kidney failure endocrine

Answer 6

Decreased calcium
Anaemia
Increased parathyroid hormone

Question 7

Kidney failure excretory

Answer 7

Increased urea
Increased creatinine
Decreased insulin requirement

Question 8

Kidney failure plasma CO2

Answer 8

Decreased

Question 9

Kidney failure plasma O2

Answer 9

Increased

Question 10

Kidney failure base excess

Answer 10

Decreased

Question 11

Kidney failure and salt and water secretion

Answer 11

Reduced

Leading to hypertension, oedema and pulmonary oedema

May also be seen in tubulointerstitial disorders - damage to concentration mechanism and hypovolemia may be the cause of AKI

Question 12

Kidney failure acidosis

Answer 12

Reduce excretion of hydrogen ions
Retention of acid bases
Leading to anorexia and muscle catabolism

Question 13

Kidney failure hyperkalaemia

Answer 13

Due to acidosis, hydrogen ions go into cell which forces potassium out, but not getting rid of potassium
Decreased distal tubule potassium secretion

Question 14

Symptoms of hyperkalaemia kidney failure

Answer 14

Depend on chronicity

Cardiac arrhythmias
Neutral and muscular activity
Vomiting

Question 15

Kidney failure hyperkalaemia ECG

Answer 15

Peaked T waves
P wave broaden - reduced amplitude - disappear 
QRS widening
Heart block
Asystole 
VT/VF

Question 16

Reduced 1-25 vitamin d levels

Answer 16

Reduced intestinal calcium absorption
Hypocalcaemia
Hyperparathyroidism

Question 17

Additional cardiovascular risks

Answer 17

Inflammation
Oxidative stress
Mineral/bone metabolism disorder

Question 18

Kidney failure initial management

Answer 18

Fluid balance and hyperkalaemia management

Question 19

Fluid balance

Answer 19

Hypovolaemic - give fluids

Hypervolaemic - trial of diuretics/dialysis

Question 20

Hyperkalaemia management

Answer 20

Drive into cells - sodium bicarbonate and insulin dextrose
Drive out of the body - diuretics/dialysis
Gut absorption - potassium binders

Question 21

Long term conservative management

Answer 21

Erythropoietin injections to correct anaemia
Diuretics to correct salt water overload
Phosphate binders
1-25 vitamin d supplements
Symptoms management

Question 22

Assessment urea

Answer 22

Poor indicator

Confound by diet, catabolic state, GI bleeding

Question 23

Assessment creatinine

Answer 23

Affected by muscle mass, ace, race, sex

Trend helpful

Question 24

Assessment radionuclide studies

Answer 24

EDTA clearance

Reliable but expensive

Question 25

Assessment creatinine clearance

Answer 25

Difficult for elderly to collect an accurate sample

Overestimates GFR at low GFR as small amount of creatinine is also secreted into urine

Question 26

Assessment insulin clearance

Answer 26

Laborious - research only